Healthcare Provider Details

I. General information

NPI: 1043578180
Provider Name (Legal Business Name): BRIAN YO-MING KUO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2012
Last Update Date: 12/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 LAS TUNAS DR D
ARCADIA CA
91007-8584
US

IV. Provider business mailing address

1613 CHELSEA RD 308
SAN MARINO CA
91108-2419
US

V. Phone/Fax

Practice location:
  • Phone: 626-278-8669
  • Fax:
Mailing address:
  • Phone: 626-278-8669
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0401413979
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number65039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: